Contemporary results of total femoral arthroplasties for non-oncological conditions

Contemporary outcomes of total femoral arthroplasties (TFAs) in the non-oncological setting are limited. This study aimed to assess implant survival free from revision and reoperation, clinical outcomes, and radiological results associated with TFAs for non-oncological conditions.

We identified 24 patients who received TFAs between 1 January 2007 and 31 December 2021 through our institutional total joint registry. The patients' mean age was 66 years (48 to 83), mean BMI was 33 kg/m² (21 to 54), and median follow-up was four years (IQR 2 to 5). Bearings used included eight flat-faced polyethylene bearings, seven dual-mobility constructs, six constrained liners, and three face-changing liners. Of the 24 patients, 17 had a previously documented periprosthetic joint infection (PJI) and 12 were treated with chronic antibiotic suppression following their TFAs.

The two-, five-, and ten-year survivals free of any revision were 66%, 51%, and 34%, respectively. There were 12 revisions: five for hip dislocation, four for PJI, one for aseptic tibial loosening, one for prosthetic knee dislocation, and one for acetabular loosening with pelvic discontinuity. The two-, five-, and ten-year survivals free of any reoperation were 53%, 47%, and 34%, respectively. In addition to the stated TFA revisions, one patient required open reduction of a hip dislocation, and two patients required superficial irrigation and debridement procedures for wound complications. Mean Harris Hip Scores improved from a mean score of 48 to 69 (p = 0.002), and Knee Society Scores improved from a mean score of 56 to 71 (p = 0.110). At final follow-up, 20 patients had TFAs in situ, but four patients had been treated with hip disarticulation due to recalcitrant infection. All but one tibial and all non-revised acetabular components were radiologically well-fixed at final follow-up.

The use of TFAs in the non-oncological setting, mostly for salvage of multiply revised hips with previous PJI, had a low five-year survival free from any revision of 51%, mostly for hip dislocation and infection. Nevertheless, clinical outcomes improved in this challenging cohort of patients.